CC Inflammatory Bowel Disease and Urinary Obstruction Case Study Paper

CC Inflammatory Bowel Disease and Urinary Obstruction Case Study Paper

Urinary Obstruction Case Studies The 57-year-old patient noted urinary hesitancy and a decrease in the force of his

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urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. Studies Routine laboratory studies Intravenous pyelogram (IVP) Uroflowmetry with total voided flow of 225 mL Cystometry Electromyography of the pelvic sphincter muscle Cystoscopy Prostatic acid phosphatase (PAP) Prostate specific antigen (PSA) Prostate ultrasound Results Within normal limits (WNL) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate 8 mL/sec (normal: >12 mL/sec) Resting bladder pressure: 35 cm H2O (normal: 15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, Small bowel series, No change in glucose level (normal: >20 mg/dL rise in glucose) Constriction of multiple segments of the small intestine Diagnostic Analysis The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. Critical Thinking Questions 1. Why was this patient placed on immunosuppressive therapy? 2. Why was the Meckel scan ordered for this patient? 3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?
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